Inspection on 17/09/09 for Holmewood Manor Care Home

This inspection was carried out on 17th September 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holmewood Manor Care Home 05/08/08

Holmewood Manor Care Home 02/08/07

Holmewood Manor Care Home 13/03/07

Holmewood Manor Care Home 25/07/06

Holmewood Manor Care Home 08/02/06

Holmewood Manor Care Home 19/10/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Holmewood Manor Care Home Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH Lead Inspector Susan Richards Key Unannounced Inspection 17th September 2009 12:37 DS0000064198.V377684.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmewood Manor Care Home Address Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH 01246 855678 01246 852953 holmewood@hallmarkhealthcare.co.uk www.hallmarkhealthcare.co.uk Hallmark Healthcare (Holmewood) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following categories of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Old age, not falling into any other category Code OP The maximum number of service users who can be accommodated is 40. 5th August 2008 2. Date of last inspection Brief Description of the Service: Holmewood Manor care home provides accommodation, personal care and support for up to 40 older persons. It is located off the main road in the village of Holmewood, near Chesterfield and close to Junction 29 of the M1 motorway. The home comprises of 34 single bedrooms, 22 of which have an en suite facility and three double bedrooms, all having an en suite. Single bedrooms without en suites have wash hand basins fitted. There is a choice of lounge and dining rooms to each floor, accessible by both stairs and a shaft lift. There are also a number of environmental adaptations and equipment provided to assist persons with physical disabilities. There is level access to very pleasant gardens, with areas provided for relaxation and stimulation, including seating and garden tables and also car parking spaces. Activities are organised on a regular basis, and details of these can be found in the entrance hallway, along with key information about the home, including a copies of our last key inspection report. Twenty-four hour staffing is provided from a team of care support and hotel services staff. Catering and laundry services are centralised, although there is a small laundry facility for service users who may wish to launder personal items. The home is currently managed by the regional support manager, with no registered manager for the service. The range of fees is £336.42 to £355.21 per week excluding hairdressing, private chiropody, toiletries and newspapers, for which there are additional charges as per vendor. Information about fees is correct at the time of this inspection, as provided by the home’s administrator. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. This inspection visit also included assessing compliance with previous requirements made and the meeting of key national minimum standards. We sent out 10 surveys to people living in the home and received 2 responses. We sent out 10 surveys to peoples’ relatives or representatives via individual service users and 5 staff surveys. We received 2 responses from peoples’ relatives or representatives and 2 from staff. There were 21 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. We were assisted by the manager. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during our visit where we looked more closely at the quality of care and services received by 3 people living in the home. We did this by speaking to them and/or their relatives, observation, reading their care records, and talking to staff. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.2 Page 6 All of the above was done with consideration to the diversity needs of people accommodated at the home. At the time of our visit there were all British white male and female residents of Christian religion. What the service does well: People are suitably informed about the service to assist them in moving there. Overall, peoples’ healthcare needs are met and they are treated with respect and their dignity and privacy rights promoted. People are provided with opportunities to exercise choices in relation to their daily lives in the home. People are provided with nutritious food, which they enjoy. People are confident that concerns or issues they raise will be listened to and acted on. Suitable systems, including staff training and written procedures, are in place to promote peoples protection from harm and abuse. People live in a safe, clean and well maintained environment, which is suitably equipped and which suits their needs. People are supported from staff that is effectively recruited and inducted. We received a number of comments from people, including – ‘Its like a palace here, staff are friendly and caring.’ ‘I am very happy here. Staff help me when needed.’ ‘Good relationships with staff.’ ‘Food is lovely and different every day. What has improved since the last inspection? Record keeping practises have improved. These include – For peoples’ needs assessment, care planning and medicines administration records. For the maintenance and servicing of equipment. For staff recruitment records, ensuring two written references are provided for all new staff employed. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 3. (The home does not provide for intermediate care). People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are suitably informed about the service to assist them in moving there and their needs are mostly accounted for. EVIDENCE: In our AQAA the home told us that people are invited to visit the home; are provided with the information they need about the service and their needs assessed before they move there. They did not tell us about any improvements made or aimed for relevant to this outcome section. However, Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 10 they gave us some statistical information that we asked for about the people accommodated there. At this inspection there were twenty one people accommodated. People told us they received the information they needed about the service before moving there and said that their needs, including medical needs are usually met. We looked at the recorded needs assessments for three people. These were formulated using a standardised format and mostly accounted for risks to peoples’ safety with regular reviews recorded in their respect. Copies of their single assessment and care plan summaries provided by the local authority for the purposes of their placement at the home were also kept. However, there were some elements where needs assessment information was not fully recorded. This meant some areas on the assessment format were left blank. There were also occasions where the person completing the information had not signed and/or dated their entry. Management told us about their action plan to drive improvements following Concerns have been raised recently with the home from the local funding authority for peoples’ placements there, via their individuals’ care reviews. These included concerns about record keeping for peoples’ needs assessment and care planning records. Management told us about their action plan to drive improvements here. We saw that this includes for the regular auditing of needs assessment and care planning records to measure their completion against nationally recognised standards. Their most recent audit, completed some time period before our inspection visit scored 62 percent with an action plan determined. We saw that peoples’ mental capacity to make key decisions about their care and treatment was not effectively accounted for within their needs assessment records in accordance with the Mental Capacity Act 2005. We discussed this with the manager and also referred her to a decision recorded in one persons care plan for their treatment. The decision was recorded in isolation and was not signed by the service user or the person recording this. The manager provided a standardised assessment format recently determined for this purpose and told us this was to be completed in respect of each service user by way of priority. We saw that some staff had received training regarding the Mental Capacity Act and with additional training planned to support the introduction of the new assessment format. We also saw that the home does not currently use a specific nationally recognised trigger tool in relation to determining individuals’ nutritional risk and the need for medical or dietetic referral. Although we could see that staff Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 11 were monitoring and recording peoples weights and nutritional intake in accordance with their written care plan, where they felt they may be at risk. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, peoples’ healthcare needs are met and they are treated with respect and their dignity and privacy rights promoted. EVIDENCE: In our AQAA the home told us that peoples written care plans demonstrate the necessary care interventions to ensure their needs are met and that these are reviewed at least monthly intervals. They told us about they could do better in relation to the provision of staff guidance for the administration of peoples medicines that are administered on as required basis. Although they did not tell us if, how, what or when they Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 13 were going to achieve this. We have referred to our inspection findings for these below. They gave us some other information that we asked for, telling us that they use a nutritional screening tool for people, which is regularly reviewed. We have detailed what we found in respect of this under Section One of this report and have made a good practise recommendation there. They told us that no staff member has received training in malnutrition care and assistance with their eating, including those who serve and prepare food. Although did not detail this as an area for action or improvement. We have made a requirement about this under the Staffing section of this report. Information also provided there was that there had been no pressure ulcer incidences in the last twelve months. However, a written notification was sent to us during that time period, telling us that one person had developed pressure ulcers, together with the action being taken to address this. This was confirmed at this inspection as satisfactory. We have referred to the quality of information provided in the AQAA under the Management section of this report. At this inspection people told us that their care needs, including medical needs were usually met. They said they had good relationships with staff and that their dignity and privacy needs are met. They also told us they are able to access outside health and social care professionals, including for the purposes of their routine health screening. Care plans and associated healthcare records reflected this. We received a number of positive comments from people, including: ‘Its like a palace, staff are friendly and caring.’ ‘I am very happy here. Staff help me when needed.’ ‘Good relationships with staff.’ For the most part, peoples written care plans detailed the action to be taken by staff to meet peoples assessed needs. We did observe some omissions in the recording of peoples care plans, including staff signatures and signatures of the service user, together with dates when these were written. We have also referred to these under the Choice of Home section of this report. However, we could see that care plans were being regularly audited by management as part of their drive to improve their quality. We saw that following recent management changes at the home. That satisfactory action was being taken, for multi disciplinary care plan reviews to be requested for people where necessary and where some of these had not previously been acted on in a timely manner. This was of particular importance for one person, with ongoing complex and challenging needs, who had not been subject to necessary care review for some time. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 14 Overall, we found the arrangements for the ordering, receipt, storage, recording, administration and disposal of peoples’ medicines to be satisfactory and mostly in accordance with recognised practise standards for these. That requirements we made about medicines practises at our last key inspection were met. We also saw that the arrangements for these were being closely monitored and audited by management on a daily and weekly basis. However, we did find some areas which require attention as follows, Care plan protocols were introduced for some people in respect of medicines that are prescribed to be taken as required, rather than at regular intervals. These provided clearer instructions for staff to follow regarding their administration. However, one person that we case tracked was recently prescribed and administered an as required medicine on the 14 September 2009 by their GP. There was no care plan protocol in place at our inspection visit on 17/09/09 We discussed the importance of this with staff responsible, given that this medicine is not one that the service user themselves would ask for. But, this is wholly reliant on staffs’ assessment and determination as to the need for its administration to that person under specific circumstances. We also saw where one person was prescribed a skin cream, which staff administered, together with one administered by the district nurse. The one to be administered by staff in the home was not being signed as given, nor a coded reason recorded as to why it was not given) on the medicines administration record sheet. Although there were written entries in that persons’ daily care record for its administration. We also saw that the creams were not safely stored. However, suitable refresher training was being rolled out to all staff responsible for peoples’ medicines, which included an assessment of their competency. With around half of staff having completed this and dates set for the remainder. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 15 Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with opportunities to exercise choices in relation to their daily lives in the home and the home knows what improvements it needs to make in respect of activities provision for people. People’s capacity to exercise personal autonomy and choice is not always best accounted for and therefore may not be fully maximised. People are provided with nutritious food, which they enjoy. EVIDENCE: In our AQAA the home told us they give people freedom of choice and control with regard to their daily living routines and provide them well balanced and nutritious meals and a choice of surroundings to eat in. That they ensure people receive the assistance and support needed, with advice from outside healthcare professionals as may be necessary for their nutrition. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 17 They told us they felt they could improve their record keeping in respect of activities provision and also by way offering more outdoor activities for people. Although they did not tell us if, how or what they were going to achieve this. They told us they have introduced named staff with delegated responsibilities as ‘champions’ for promoting the quality of peoples dining experience in the home. At this inspection people told they enjoy the meals provided and that snacks and drinks are available in between meals, including at supper time. Comments received, include – ‘Food is lovely, a different menu every day.’ ‘We are asked every day from a choice of menu.’ Staff serving lunches and mid morning and mid afternoon drinks and snacks did so in a calm and unhurried manner. Tables were attractively set at lunchtime and people chose where and what to eat. People told us that the cook speaks with them individually each morning to obtain their menu choices for that day. Although some said they couldn’t remember what they had chosen. There was no daily menu board displayed to assist them in this respect. One person told us there used to be written menus available, but that they had not seen these for some time. We saw that staff recorded some peoples’ nutritional and fluid intake in order to provide a monitoring record in accordance with their written care plans. Records of peoples’ individual weights were also maintained. People told us there were some activities, events and entertainments organised in the home that they could join if they wished. Some spoke about a recent trip to Carsington Water and said they were supported to maintain contacts with the families and friends, with open visiting to the home. Daily and activities records that we looked at for three people case tracked detailed their engagement in a pancake tossing event, an animal day, Old Time Musical event with popcorn, country and western themed event, bingo, board games and a chair based exercise session. However, these were over a three month period. One person told us they regularly receive Holy Communion on an individual basis by a visiting minister to the home, as is their preference. We saw that people were able to personalise their own rooms, with their own possessions and furnishings as they wished. For two people that we case tracked, records of their belongings, including furniture, clothing and personal Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 18 items were kept in their care files, although for one person these had not been recorded. We also saw that the home had received a complaint since our last inspection concerned a missing personal item of furniture. Management advised there were no records for this. We have referred to this under the Complaints section of this report and have made a requirement about this. We were advised that no service user managed their own financial affairs, although there was no information recorded in peoples’ needs assessment records about those arrangements, including as to their choice or capacity to do so. We have referred to this under Section One of this report and made a recommendation about this. The activities co-ordinator had been absent for some time and efforts were being made to provide some activities by bringing in named staff from other homes within the company, on a regular but not daily basis. Individual board games and newspaper reading were organised for some people during our visit via those arrangements. Some information was displayed for people about activities and entertainments and also photographs of people engaging in activities. For the three people we case tracked. Each had a comprehensive ‘Life Story’ recorded in their care records, together with details of their preferred daily living routines, interests and hobbies. A recent management audit of activities provision identified action for improvements here. This included, - That daily activities are offered and with further developments so that these are more targeted to peoples’ individual interests. - That a newsletter is introduced. - That relative and residents meetings/committees instigated. We will assess progress with these at our next key inspection here. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that concerns or issues they raise will be listened to and acted on. Although complaints are not effectively recorded and people are not best informed about who to contact and how for the various stages of the complaints procedure. Suitable systems, including staff training and written procedures, are in place to promote peoples protection from harm and abuse. EVIDENCE: In our AQAA the home told us that they record all complaints and liaise with outside agencies where needed. That the complaints procedure is made available for people and that staff are trained to recognise abuse and to safeguard people from harm and abuse. They told us they could improve by completing any complaints investigations within a shorter timescale and by working towards reducing the number of complaints they receive to nil. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 20 They also told us they received two complaints within the last 12 months, none of which were substantiated and with one resolved within 28 days. At this inspection we saw that a copy of the complaints procedure is displayed in the home and information about how to make a complaint is also provided within the home’s service guide for people. Although the complaints procedure refers to the designation of people within the organisation to contact for some stages of the procedure, it does not give any names or contact details. At this inspection people told us they would speak with the staff in the home if they were unhappy or had any concerns and were confident that these would be dealt with. However, people were not sure as to how to make a formal complaint other than raising it with the staff in the home. The home’s complaints records for two complaints received were incomplete in their recording. One alleged failures in standards of care and communication and also missing personal items/belongings of a service user. Although this was recorded as resolved, records did not fully account for this. The second alleged a missing large item of personal furniture belonging to a service user. There was no record as to the investigation of this complaint nor any outcome or action taken. Both of the above were received by an acting manager for the home, absent from duty since July 2009. Interim management arrangements are in place and we saw that an audit of complaints received by the home over the last 12 months had been conducted, indicating the poor recording for these. Management advised they were seeking to obtain further information in their respect to ensure their proper recording and redress/action as may be necessary. On the day of our visit management received a further verbal complaint in respect of alleged missing personal items belonging to a service user. Management recorded this and assurances were given that this would be properly reported and investigated in accordance with required procedures. The home has also recently provided us with written notification of a complaint made relating to the conduct of a named staff member. This was referred for investigation under joint agency safeguarding procedures and suitable action taken to ensure the safety of people accommodated at the home. Staff spoken with was conversant with procedures to follow in the event of witnessing or suspecting the abuse of any service user and confirmed training is provided annually for this by way of a rolling programme. Training stats that we saw collated up to September 2009 detailed that all staff, except two hotel services staff have received this training within the last year. We have referred to this in the staffing section of this report. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 21 Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, clean and well maintained environment, which is suitably equipped and which suits their needs. EVIDENCE: In our AQAA the home told us that they provide a safe, well maintained and homely environment for people. Where ten staff is trained in infection control and with provision of equipment as may be necessary to meet peoples’ needs. The AQAA provided little information as to specific improvements here. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 23 At this inspection people told us the home is kept clean and fresh. All areas that we saw were clean, odour free, well maintained and suitably decorated, furnished and equipped. There were no observable hazards to peoples’ safety. Bedrooms that we looked at in relation to people we case tracked were easily located by way of name plates and/or signs to their doors. They were personalised and suited their needs, including the provision of aids and equipment in accordance with their risk assessed needs. People are able to access a choice of toilet and bathing facilities adapted to meet with their mobility needs and also a choice of communal lounge and dining space. Two people told us they like to use the large walk in shower provision on a regular basis. Many rooms provide en suite facilities, which are wheelchair accessible and all areas were warm, well lit and ventilated. One person case tracked was accommodated in a large room with space for their mobility needs and use of their electric wheelchair. Suitable hand washing facilities and waste bins were provided in all communal, clinical and laundry areas, including containers for the transportation of clean and dirty linen. A separate laundry facility is provided, which is kept clean and tidy and with dedicated areas for the circulation of clean and dirty linen. Gardens are well kept and attractive, with a circular walk way around the home, a water feature, bird table, patio areas and seating for people. Some people told us they enjoy the garden. We also saw that a home audit was undertaken and recorded in order to monitor the quality and safety of the environment and with action recorded where identified necessary. However, we did not see a specific infection control audit. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported from staff that is effectively recruited and inducted, although not best trained and deployed. Although with management strategies determined to address these. EVIDENCE: In our AQAA the home told us that they ensure staffing levels are ensured at ten percent over peoples care needs and that they keep the use of agency staff to a minimum. That they operated a comprehensive induction programme for staff and encourage them to undertake National Vocational Qualifications in care. They did not identify any improvements they could make relevant to the homes current registration. They merely stated they had improved the stability of their staff group via incentives, but with no clarification as to what this might mean. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 25 They gave us some statistical information that we asked for in relation to staff employed, although some of the numerical data provided was inconsistent and not fully completed. At this inspection staff told us about the arrangements for their recruitment, induction, training and deployment. This told us that there are suitable arrangements in place for their recruitment and induction and records that we saw reflected this. However we also saw that gaps in staff training, including areas of core health and safety training and updates that are overdue. We were provided with evidence of training organised in respect of some of these, including fire and medicines training. We also saw that nine out of sixteen care staff had achieved at least NVQ level 2 in care and with others signed up and due to commence this. The manager provided a copy of a recent training needs analysis she had undertaken during September. This also identified significant gaps in staff training and including infection control, care planning, dementia awareness, dealing with aggression, Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding 2009. The manager advised that this training was to be organised. The training needs analysis did not include for malnutrition care and assistance with eating and drinking, falls management or pressure ulcer prevention. All staff told us that that staffing levels were not always sufficient to effectively meet peoples needs and for their safe supervision. Staff feedback and information that we looked at, including duty rotas and peoples care records told us – There are twenty one residents accommodated with three care staff provided throughout the day and two at night. The manager is in addition to this. Although with management responsibility for a sister home set in the same grounds. There was also additional staff time for some activities provision. The latter is not provided on a daily basis. There were approximately six people who required two or more staff to assist them during the day and at night. This means there are times when lounge areas and residents are left unsupervised. All staff spoken with felt this to be insufficient. Residents said they sometimes had to wait for staff assistance, but felt that staff worked hard to meet their needs and usually help them when needed. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 26 One person had recently wandered out of the home and was returned by a third party during the early evening. Staff on duty was not aware until their return. That they were missing. Records told us that there was three care staff on duty at the time of this incident. The manager assured us she was in the process of undertaking a review of peoples dependency needs in order to determine necessary staff deployment requirements. We saw peoples’ individual dependency scores were recorded within their care files. The review of dependency arrangements did not include consideration as to those dependency scores. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Existing management arrangements ensure the home is run mostly in peoples’ best interests and their health, safety and welfare is promoted. EVIDENCE: We found that the AQAA was not effectively completed by the manager. With many areas left blank, together with conflicting and duplicated information from the previous years’ annual AQAA submission. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 28 At our previous inspection we made a requirement for that manager to submit an application for their registration with the Commission. This was not submitted. That person was also absent from duty for some time at this inspection. The provider notified us in writing of this and for the management arrangements in their absence. Since our last inspection and more recently, we have also been notified of concerns from the local authority responsible for funding peoples’ placements at the home. Via individual care reviews they conducted. These concerns related primarily to the management of the home, some of its record keeping practises and related staffing issues. At this inspection we discussed the contents of the AQAA, the arrangements for the management of the home and were professionally assisted by management at our visit. Staff said they mostly receive the support they need and told us about some new ways of working that have been recently introduced to improve communication about the needs of people they support and care for. We spoke with the manager about their quality assurance and monitoring systems and saw records for recently recorded full home audits, together with reports of recent visits by a representative of the registered provider. Home audits indicate a scoring system for each area and an overall total score, being 70 percent for September 2009. Action plans has been devised for areas indicated from these. These include record keeping for peoples’ needs assessment and care planning records, medicines management and practises, social activities, complaints management and staff training. We have also referred to these areas in the relevant outcome sections of this report and made some requirements and recommendations relating to these. Management advised there was no evidence of any recent formal consultation with people about the care and services they receive, or with people who have an interest in the service. They told us this is to be addressed. Staff told us that some had received training for the Mental Capacity Act 2005 and the manager advised that further training was to be rolled out. Although, we found there was no policy and procedural guidance in place for staff to assist them in applying the principles of these and to account for people’s capacity to make decisions about their care and their treatment. The home provides safekeeping facilities only in respect of peoples’ personal monies. The most recent home audit of these scored 100 percent. We also looked at these via people that we case tracked and found them to be satisfactory. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 29 At our last key inspection here we made a requirement about the maintenance and servicing of specified equipment in the home. The provider submitted satisfactory evidence of the achievement of this. At this inspection we were also provided with further information about the arrangements for the servicing and maintenance of equipment at the home, which tells us, this is being kept up to date. Staff told us about the arrangements for ensuring safe working practises, including the satisfactory provision of equipment. We have referred to staff training arrangements under the Staffing section of this report and made a requirement about these. We saw that people case tracked, were provided with equipment in accordance with their assessed needs and saw properly completed accident and incident reports for one of them. Monthly falls audits were also being reviewed by the current manager. During our visit we saw that the home was clean and odour free and with no observable hazards to peoples safety. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X 2 2 Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) & 17(3) Requirement There must be suitable arrangements in place for the safekeeping, recording and safe administration of medicines – Creams and lotions must be kept in a suitable lockable storage facility, including where these are kept in peoples own rooms. Individual written care plan protocols must be in place for staff to follow in respect of ‘as required’ medicines prescribed to a service user. For all prescribed medicines, including creams and lotions. Staff responsible for their administration must sign the administration record sheet when these are given or enter the appropriate code to indicate the reason why not. So as to ensure their safe storage, recording and administration. Any complaint received under the complaints procedure must DS0000064198.V377684.R01.S.doc Timescale for action 31/10/09 2. OP16 22(3) &(8) 31/10/09 Page 32 Holmewood Manor Care Home Version 5.3 be fully investigated. A written summary of the three complaints made during the preceding 12 months (relating to missing personal items) must be forwarded to the Commission detailing the action that was taken or is being taken in response. At all times there must be persons working in the care home in such numbers (and suitably qualified and competent) as are appropriate for the health and welfare of service users. Staff must receive training appropriate to the work they are to perform. So as to ensure they are competent to do their jobs. The homes training plan must also include training for staff in malnutrition care and assistance with eating and drinking, falls management and pressure ulcer prevention. A registered manager must be appointed for the home. 3. OP27 18(1)(a) 31/10/09 4. OP30 18(1)(c) 31/12/09 5. OP31 9 31/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP3 Good Practice Recommendations A recognised risk assessment trigger tool should be used such as the MUST scoring so as to accurately determine individual nutritional risk and the need for dietetic referral. The admission and needs assessment process should DS0000064198.V377684.R01.S.doc Version 5.3 Page 33 Holmewood Manor Care Home 3. OP3 4. 5. 6. OP12 OP15 OP16 7. OP26 8. 9. OP27 OP33 10. OP33 include - Recording whether a person has made an advanced decision on receiving care and treatment, and if they have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Persons Representative. - Consideration of the persons’ capacity to make decisions about their daily lives, care and treatment. NMS OP 7 also applies here. All areas of peoples’ needs assessment and care planning records should be fully completed and signed and dated by the person completing them in accordance with recognised practise standards for records and record keeping. Activities provision for people should be further developed to increase access and choice for people in accordance with the known preferences and capacities. A daily menu should be provided and be visible for people. The homes written complaints procedure should provide people with the names and contact details of persons to contact at the various stages of the procedure. So as to provide people with the information they need to progress with the complaints procedure as may be necessary. The home should introduce a quality monitoring tool for infection control with measures in accordance with the Department of Health ‘Essential Steps’ guidance and practise standards. A recorded staff training plan should be introduced in conjunction with the staff training needs analysis. Suitable policy and procedural guidance should be provided for staff as to how the home shall implement the considerations of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2009. Methods should be developed for seeking peoples’ views about the services they receive from the home and also the views of people who have an interest there. So as to ensure people are regularly and effectively consulted with. Holmewood Manor Care Home DS0000064198.V377684.R01.S.doc Version 5.3 Page 34 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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